Tobacco cessation rates in the U.S. have changed little in the last decade. New interventions for smoking cessation are clearly needed. Text messaging has been identified as a promising modality for delivering smoking cessation support. There is little existing research which examines models that integrate text messaging interventions for smoking cessation within healthcare systems. Healthcare systems are important sites for delivering smoking cessation support given that 70% of smokers visit a physician each year. Integrating services within healthcare enables coordination of behavioral and pharmacologic interventions and leverages patient-provider relationships. Poor adherence to smoking cessation medications is thought to limit their effectiveness. Text-messaging has been used to promote adherence to medication in other condition but the use of text messaging to promote smoking cessation medication is not well studied. The proposed scientific program has two research aims: (1) To conduct qualitative focus groups among smokers (n=30) in community health centers to assess their preferences for text messaging from their healthcare provider and to explore their experience with nicotine replacement therapy and barriers to medication adherence in order to inform the design of a text messaging intervention, and (2) To test, in a pilot randomized controlled trial (N=106), the effect of delivering behavioral smoking cessation content with pharmacotherapy support by text message plus nicotine replacement therapy on self-reported quit attempts (intentional non-smoking for =24 hours), pharmacotherapy adherence, and biochemically confirmed smoking abstinence at the end of treatment. The principal investigator (PI) proposes a career development program that includes methodological training and mentorship by Harvard faculty to design and evaluate a text messaging intervention targeting smokers in community health centers. The long-term goal of this career development award is to develop Gina Kruse M.D., M.S., M.P.H. as an independent tobacco cessation researcher with expertise in technology-based solutions for vulnerable populations. During the five-year award period, she will develop a knowledge base that supports the development, implementation, and evaluation of a text messaging intervention for smoking cessation among primary care patients. Career development activities will include training in qualitative research, use of mobile technologies as a communication method for delivering health advice, and clinical trial design. This proposal addresses important gaps in the literature including the feasibility of integrating text messaging programs for smokers into healthcare systems and examining the effect of text messaging on smoking cessation medication adherence.